Emergency Psychiatry. Marcela Almeida, MD Department of Psychiatry. A Hot One. You get paged by the ED resident to evaluate a patient who is apparently wreaking havoc.
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Marcela Almeida, MD
Department of Psychiatry
You get paged by the ED resident to evaluate a patient who is apparently wreaking havoc.
“He’s a hot one,” the resident says. “He’s screaming insults at every one and smashing his fists against the walls. We’re this close to pumping him with Vitamin H [haloperidol]”.
“You’ll find him waiting for you in the seclusion room.”
24 yo African American male with no significant past psychiatric history and a past medical history significant for asthma who is brought to the ED by paramedics contacted by the pt’s girlfriend, who arrives with the pt. She relates a two week period of escalating aggression, insomnia, agitation, bizarre behavior, and non-sensical, incoherent ideas culminating in a nearly violent altercation today in which the pt accused the girlfriend of being in league with possibly demonic forces bent on sucking out his gray matter.
“Dying is an art, like everything else. I do it exceptionally well. I do it so it feels like hell. I do it so it feels real. I guess you could say I've a call”. Sylvia Plath
You enter the pt’s room and immediately notice the wild-eyed expression, the psychomotor agitation, and the hands curled into fists. He starts to approach you, screaming, “The soul! The gray matter! The Israelis! Cannibals! Where’s your pumpkin, Uncle Sam?” He waves his arms wildly.
You say, calmly, “I’m your doctor and I’m here to evaluate you.”
He screams – “Gutter!” – and rushes towards you.
You close the door, having identified him as a stage 3 or 4; he bangs loudly on the door, yelling “Doctor Gutter Doctor Gutter!” You obtain help.
He clearly needs to be hospitalized for apparent psychosis.
Furthermore, he meets criteria for involuntary admission given his aggressive, violent tendencies.